Individual
DR. ERIC MARK WIEBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19880
NE
207RN0300X
Nephrology Physician
Primary
19880
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110111372
PALMENTO GBA RR MEDICARE
—
Enumeration date
08/04/2006
Last updated
04/20/2012
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